or search evidence on Discover Portal

Dissemination Centre

Evidence at a glance

The headline findings from the studies featured in this Highlight are as follows:

  • For induction of labour, the use of misoprostol and of oxytocin together with artificial rupture of membranes (only for women with favourable cervix) are more successful than other methods in achieving vaginal delivery within 24 hours
  • For women aged 35 or older, inducing labour at 39 weeks of pregnancy rather than waiting for it to start spontaneously did not increase the rate of caesarean section and had no adverse short term effects on outcomes for the mothers or their babies
  • Among low-risk first-time mothers of any age, inducing labour at 39 weeks rather than waiting for it to start spontaneously did not significantly reduce the frequency of problems in newborn babies but did significantly reduce the rate of caesarean section
  • For women whose pregnancy had gone beyond term (usually 41 weeks or more), inducing labour after the due date slightly lowers the risk of stillbirth or infant death soon after the birth, although this risk is low
  • A review found no evidence that labouring in water increases the risk of adverse outcome for women or their newborn babies and labouring in the water may reduce the number of women having an epidural. But there has not been a trial in a midwifery-led setting so at present there is not enough information either way on the use of immersion in water during the second stage of labour. A study is underway to establish the safety of waterbirth for mothers and babies
  • For women having continuous electronic fetal monitoring while in labour, computerised interpretation of the fetal heart rate (as compared to midwives & doctors looking at the graphs without computer assistance) did not improve outcomes in the neonatal period at two years after the birth
  • First-time mothers who were in good health and were not planning an elective caesarean found that attending two self-hypnosis groups and using a daily audio self-hypnosis CD did not reduce their use of epidural in labour, but did reduce their expected levels of anxiety and fear during the labour and birth
  • For women who asked for opioid pain relief during labour, it was found that the use of remifentanil via a patient-controlled pump halved the proportion who went on to have an epidural, compared with those receiving pethidine by injections. Women in the remifentanil group were happier with their pain relief, and went on to have fewer instrumental vaginal deliveries
  • For women with an epidural in place, lying down on their side as the baby is being delivered achieved more spontaneous vaginal births than in an upright position]
  • For women without an epidural, it was found that an upright position for delivery brought about a very small reduction in the duration of the second stage of labour together with a reduction in episiotomy rates and rates of assisted deliveries, but there was an increased risk of blood loss greater than 500ml

These headline findings form part of our Highlight on the Management of Labour which takes an evidence-based look at induction, pain relief, waterbirth and more . To read the Highlight in full click here

National Institute for Health Research, Room 132, Richmond House, 79 Whitehall, London, SW1A 2NS

© 2016 - 2019 NIHR, all rights reserved